K0 - Does not have ability or potential to ambulate safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

K1 - Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.

Medicare K-levels 2-3

K2 - Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stair or uneven surfaces. Typical of limited community ambulator.

K3 - Has the ability or potential to ambulate with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activities that demands prosthetic utilization beyond simple locomotion.

Medicare K-levels 4

K4 - Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.

Wall
Relief channel located anteriomedial for adductor longus tendon
High to prevent adductor roll
Prevents medial movement of limb in socket
Brim
Same height as posterior brim or slightly lower
Socket should not press on pubic ramus

Icelandic Swedish new York (ISNY) or Scandinavian Flexible Socket (SFS)

Same design as quadrilateral
Has a flexible socket with a rigid retainer
This is NOT a hard socket, is quadrilateral in shape

Normal Shape Normal Alignment (NSNA)

ML diameter is less than the AP
Ischial tuberosity sits within the socket
Lateral wall is higher than greater trochanter
Lateral wall is set in 10-15 degrees of adduction
Usually made with thermosetting laminate hard socket, but may be soft socket with rigid retainer

Also known as ischial containment, CAT CAM (Contoured adducted trochanteric-controlled alignment method), and now Sabolich socket
Some contain both Ischium and ramus therefore creating a “boney lock” with the femur.
Closer to anatomical design
Requires test sockets and very good understanding of the theory and fitting principles

CAT-CAM

Has a flexible socket with a rigid retainer

the name refers to specialized computer program

Sabolich

“Containment” of the residual limb
High fit for rotational stability and side to side control
Flexible material for the socket—comfortable
High strength, light weight frame

Suspension

Suction
Partial Suction
Worn with a type of auxiliary suspension such as a Silesian band or belt
Silesian band or belt
A webbing belt used as auxiliary suspension
Total Elastic Suspension (TES Belts)
Another type of auxiliary suspension
Sometimes called a neoprene belt
Pelvic Band with Hip Joint

Simple
Made of cotton/Dacron webbing
Relatively low profile
Controls rotation well
Auxiliary suspension
Used with partial suction-Patient wears a sock

Total Elastic Suspension (TES Belt)

Very simple to use
Somewhat bulky
Moderate rotational control
Prosthesis may “telescope”
Auxiliary suspension-used with suction, roll on silicone suction, or partial suction

Pelvic Band with Hip Joint

Bulky
Very stable in M/L and Rotational control
Indicated for
Weak hip abductors
Short femur
Uncomfortable
Some patient’s are just used to it and like it (they’re old)

Roll-on Silicone Liner with Pin with shuttlecock and lanyard

Liners now being used for transfemoral applications. Used with patients who have difficulty donning a traditional suction suspension
Extra guidance needed to get pin in shuttle
Lanyard used to solve this problem
Hand dexterity is a must
Makes socket longer than normal

Roll-on Seal In Liner

Provides a suction socket
Easier to don than traditional true suction
Relatively new and have had good results

Roll-on Liner with Coyote Summit Suspension

Relatively new
Prevents rotation in the socket
Easy to apply
Works like a ski boot lock

Osseointegration

Advantages
Less feeling of weight
More control of prosthesis
No perspiration, pain from socket
Easy don and doff

Other Features
Extension Assist (at terminal swing so the heel hits the ground first - it has NOTHING to do with keeping knee straight in standing)
Stance Control
Computer Controlled ($60K)
Rotator (can cross leg)
Torque Absorber

C-Leg by Otto Bock
Intelligent knee by Endolite
Controls resistance to flexion & extension
Does not provide active flexion/extension
See video
It controls knee flexion so pt doesn’t have to descend stairs with ext knee like other prostheses
Doesn’t facilitate ascending stairs, need to go one leg at a time

Where and what about a Rotator

Located Proximal to Knee Joint

Allow Pt. To Sit With Leg Crossed

Torque Absorber

May Be Specific Unit on Shank or Integral With Foot
Absorbs Torque and Thereby Decreases Shear at Residuum / Socket Interface

Transfemoral Biomechanics: how is the TF designed to facilitate movement/gait?

Must provide for ML stability of pelvis during mid-stance on prosthetic side
Lateral wall of socket adducted to give glut medius an advantage to keep pelvis level during gait
Provide AP stability of prosthetic knee between heel contact and heel off
Socket aligned in flexion approximately 5-10 degrees
Knee joint posterior to TKA line

TKA line: what about it?

Socket forward of knee
Knee posterior to trochanter and ankle if drop a plumb line

Patients can walk unassisted but with noticeable deviations
Suspension by socket that encompasses the waist
Requires a lot of gait training in order to learn the proper method of hip, knee and ankle control
Operates using momentum
Can walk very well, doesn’t have to limit activity

Who walks with stubbies initially?

Bilateral Amputees:

Limbs shorter so easier to control
Begin training with stubbies
Stubbies are basically the socket with suction cups on the bottom - it’s easier to start with this

what is it called when your ankle is your knee?

Rotation Plasty:
(e.g. Van Nes Rotation) - a procedure where the leg is amputated above the knee, the lower portion of the leg is rotated 180° and reattached - the ankle acts like a knee joint, providing extra function; more mobility and better control with a prosthesis.
PF extends the knee, DF flexes it.